高尔基蛋白-73和甲胎蛋白对原发性肝癌的诊断价值研究

Values of Golgi Protein 73 and Alpha-fetoprotein Tests for the Diagnosis of Primary Hepatic Carcinoma

目的探讨高尔基蛋白-73(GP73)和甲胎蛋白(AFP)对原发性肝癌的诊断价值。方法选择我院2010年1月—2012年3月住院的原发性肝癌患者40例为肝癌组,其他肝病患者40例为肝病组,健康体检正常者40例为对照组。检测3组受试者血清GP73和AFP水平,比较其差异并评价GP73、AFP及平行试验对原发性肝癌的诊断价值。结果 3组血清GP73和AFP水平比较,差异均有统计学意义(P=0.000)。绘制受试者工作特征(ROC)曲线发现,GP73、AFP及平行试验诊断原发性肝癌的曲线下面积(AUG)及其95%CI分别为0.964〔95%CI(0.935,0.994)〕、0.973〔95%CI(0.926,1.020)〕和1.000〔95%CI(1.000,1.000)〕。GP73、AFP及平行试验诊断原发性肝癌的敏感度、阳性预测值、阴性预测值、准确率比较,差异均无统计学意义(P>0.05);特异度比较,差异有统计学意义(P<0.05),AFP诊断原发性肝癌的特异度高于GP73(χ2=4.103,P<0.05)和平行试验(χ2=6.944,P<0.05)。GP73、AFP及平行试验诊断原发性肝癌的漏诊率分别为10%(4/40)、10%(4/40)、0,差异无统计学意义(χ2=4.286,P=0.117)。结论 GP73对原发性肝癌诊断价值与AFP相似,且与AFP具有优势互补作用,进行联合检测有助于降低原发性肝癌的漏诊率,达到早诊早治的目的,值得临床推广应用。

Objective To evaluate the values of Golgi protein 73 （GP73） and alpha - fetoprotein （AFP） tests for the diagnosis of primary hepatic carcinoma （ PHC ）. Methods A total of 40 PHC patients who were admitted to our hospital from January 2010 to March 2012 were enrolled as the PHC group, 40 patients with other liver diseases as the LD group, and 40 healthy subjects as the control group. Serum GP73 and AFP levels were tested and compared of these three groups, and the roles of GP73, AFP and GP73/AFP were evaluated. Results There were statistically significant differences of serum GP73 and AFP levels in the three groups （P = 0. 000）. In the diagnosis of PHC evaluated by ROC, the area under curve （AUC） of GP73, AFP and GP73/AFP was 0. 964 [95% CI （0. 935, 0. 994） ], 0. 973 [95% CI （0. 926, 1. 020） ], and 1. 000 [95% CI （ 1. 000, 1. 000 ） ], respectively. Whereas, the sensitivities, positive predictive values, negative predictive values and accura- cies of GP73, AFP, and AFP/GP73 were not significant different （ P 〉 0. 05 ） , but the specificities were significant different （P 〈 0. 05 ）. The specificity of AFP was higher than that of GP73 （ χ2 = 4. 103, P 〈 0. 05） and GP73/AFP （ χ2 = 6. 944, P 〈 0. 05）. The rate of misdiagnosis of GP73, AFP and GP73/AFP was 10% （4/40）, 10% （4/40） and 0 in the diagnosis of PHC, without statistically significant difference （ χ2 = 4. 286, P = 0. 117）. Conclusion GP73 is similar to AFP in the diagno- sis of PHC, and combination of GP73 and AFP tests can remarkably improve the PHC diagnosis.